Agomelatine use was associated with a 19.8% lower risk of hypertension (adjusted IPTW-HR 0.802), a 12.5% lower risk of diabetes (adjusted IPTW-HR 0.875), and a 6.2% lower risk of hyperlipidemia (adjusted IPTW-HR 0.938) compared to fluoxetine over 5 years in Taiwanese patients without baseline metabolic disorders.
Cohort (n=109,458)
Yes
Does agomelatine reduce the risk of new-onset hypertension, diabetes mellitus, and hyperlipidemia compared to fluoxetine in adult patients?
In a nationwide Taiwanese cohort, agomelatine use was associated with a significantly lower risk of incident hypertension, diabetes, and hyperlipidemia compared to fluoxetine.
Effect estimate: adjusted IPTW-HR 0.802 for hypertension (95% CI 0.770–0.836); adjusted IPTW-HR 0.875 for diabetes mellitus (95% CI 0.827–0.927); adjusted IPTW-HR 0.938 for hyperlipidemia (95% CI 0.906–0.972) (95% CI 0.770–0.836 for hypertension; 0.827–0.927 for diabetes; 0.906–0.972 for hyperlipidemia)
Absolute Event Rate: 25.51% vs 29.3%
p-value: p=<0.01 for all
Agomelatine, a melatonergic antidepressant, acts as a dual MT1/MT2 receptor agonist and a 5-HT2C receptor antagonist, effectively resynchronizing circadian rhythms while exerting antidepressant and anxiolytic properties. It is considered safe and may have anti-inflammatory, antioxidant, and blood pressure-lowering properties. However, its effects on hypertension, diabetes, and hyperlipidemia remain unclear. This study aimed to assess the association between agomelatine use and the impact on these metabolic conditions. Using Taiwan’s National Health Insurance data, this nationwide cohort study compared 25,923 agomelatine users with 83,535 fluoxetine users. Outcomes included new-onset hypertension, diabetes, and hyperlipidemia over a 5-year follow-up. An active-comparator design with propensity score weighting balanced baseline characteristics. Cox proportional hazards models provided hazard ratios (HRs) and 95% confidence intervals (CIs). All analyses were conducted using SAS. In the propensity score-weighted cohort over a 5-year follow-up, agomelatine users exhibited a significantly lower risk of hypertension compared to fluoxetine users (adjusted HR 0.802; 95% CI, 0.770–0.836). Consistent with this cardiovascular benefit, agomelatine use was also associated with reduced risks of incident diabetes mellitus (adjusted HR 0.875; 95% CI, 0.827–0.927) and hyperlipidemia (adjusted HR 0.938; 95% CI, 0.906–0.972) throughout the study period. Subgroup analyses showed generally consistent inverse associations for hypertension across various demographic and clinical strata. This nationwide cohort study demonstrates associations between agomelatine use and lower risks of hypertension, diabetes mellitus, and hyperlipidemia. These findings provide population-based evidence that may inform future research, although further studies are warranted to confirm these observations.
Wen et al. (Mon,) conducted a cohort in Users of antidepressants (Agomelatine and Fluoxetine) without prior metabolic disorders (n=109,458). Agomelatine vs. Fluoxetine was evaluated on Incidence of new-onset hypertension, diabetes mellitus, and hyperlipidemia over 5 years (adjusted IPTW-HR 0.802 for hypertension (95% CI 0.770–0.836); adjusted IPTW-HR 0.875 for diabetes mellitus (95% CI 0.827–0.927); adjusted IPTW-HR 0.938 for hyperlipidemia (95% CI 0.906–0.972), 95% CI 0.770–0.836 for hypertension; 0.827–0.927 for diabetes; 0.906–0.972 for hyperlipidemia, p=<0.01 for all). Agomelatine use was associated with a 19.8% lower risk of hypertension (adjusted IPTW-HR 0.802), a 12.5% lower risk of diabetes (adjusted IPTW-HR 0.875), and a 6.2% lower risk of hyperlipidemia (adjusted IPTW-HR 0.938) compared to fluoxetine over 5 years in Taiwanese patients without baseline metabolic disorders.